Delayed kidney transplantation after HLA-haploidentical hematopoietic cell transplantation in a young woman with myelodysplastic syndrome with renal failure

Abstract

Patients with end-stage renal disease (ESRD) are often excluded from potentially curative allogeneic hematopoietic cell transplantation (alloHCT). Our institution pioneered simultaneous living donor kidney transplantation in patients undergoing alloHCT from the same donor for hematologic malignancies. Herein, we present the case of a 31-year-old woman diagnosed with myelodysplastic syndrome who developed ESRD during cytoreductive induction therapy. She achieved disease control, then successfully underwent a human leukocyte antigen (HLA)-haploidentical alloHCT while on hemodialysis. After rapidly tapering off graft-versus-host disease prophylaxis, fourteen months from her alloHCT she received a kidney transplant from her same haploidentical sibling donor, which obviated the need for further systemic immunosuppression.

Keywords: Haploidentical; Hematopoietic cell transplant; Kidney transplant; Stem cell transplant.

Fig. 1

Schema depicting treatment course from diagnosis to kidney transplant for the patient. MDS, myelodysplastic syndrome; vyxeos, liposomal daunorubicin and cytarabine; alloHCT, allogeneic hematopoietic cell transplant; MRD-, measurable residual disease-negative; CR, complete remission; TBI, total body irradiation; cGy, centiGray; MMF, mycophenolate mofetil.